Dental Hygiene 101

We Asked Dentists To Set The Record Straight About Dental Hygiene

Teeth are a big deal. We all want a perfect, blindingly white smile, but why do we have such a hard time taking care of the one we have? A recent poll suggested that only around 50% of Brits actually went to the dentist last year. It might come down to preconceived notions we have about dental hygiene. If you brush twice a day, what else is there to do?

Turns out, a lot. While brushing is the crux of effective dental hygiene, it’s the beginning, not the end. It’s not just about having white teeth either. Gum health and bacteria levels in your mouth have just as much, if not more, to do with your long-term dental health than how clean your teeth look. It’s about the long game and consistency is key. Ineffective or negligent oral care can lead to a host of larger issues down the road: gingivitis, infection, tooth loss and even migraines and bone issues.

If you think you know everything about dental hygiene, think again. We asked actual dentists to weigh in on common myths, misconceptions and questions about how to take care of your teeth. The answers may surprise you.

Was mouthwash really first discovered as a floor cleaner?

It’s actually true. “In the early 1900s, they introduced alcohol into mouth rinses,” says Dr. Elisa Mello, DDS. (In ancient times, urine was used as a mouth rinse because of the ammonia content — but we won’t go there.) “That’s why Listerine was invented: it was first developed as a surgical scrub and to clean operating room floors.” However, the modern mouthwashes we buy today might not really be as important as we think. “I do not believe that people need mouthwashes unless they have a very serious condition in their mouth,” she says. “For the average person, it just makes your breath smell nicer.”

In fact, if there is alcohol in your mouthwash it may actually be counterproductive. Alcohol dries out your mouth, so bacteria isn’t washed away as effectively and can more easily cause tooth decay and problems with fillings. New versions without alcohol aren’t much better, as they contain other chemicals that can cause damage to our soft tissues (like our gums). Unless you have a serious ailment like periodontal disease, have a lot of cavities, or have a temporary crown that needs cleaning, Dr. Mello recommends rinsing with plain old water.

Is it possible to over-brush?

Yes, but not in the way you think. “The way that people over-brush is if they use a hard toothbrush and they scratch their enamel,” says Dr. Mello. “If you’re using a bristle that is too hard, it’s like taking brillo to your teeth.” Effective brushing should be gentle but effective. Make sure you are covering every surface of your teeth (front and back) and also between them, but not scrubbing them too hard or fast. Dr. Mello recommends brushing a little longer if you need to in order to keep it gentle.

Are electric toothbrushes just a gimmick?

No. “Throw away your manual toothbrush,” says Dr. Michael Apa, DDS. “People don’t really know how to brush their teeth properly. An electric toothbrush does it for you.” That doesn’t mean that all electric toothbrushes are created equal, though. Look for one that uses sonic technology to clean your teeth and pass over simple, battery-operated styles. “A sonic brush actually breaks up the stuff that sticks on your teeth,” he says. “Brush your teeth with it for 2 minutes and see how much cleaner your teeth feel.”

What is so important about enamel?

Two things: “Enamel is the strongest substance in our body and its purpose is to protect the inner part of the tooth,” says Dr. Mello. “If you lose your enamel, you expose nerve endings and it gets sensitive.” Enamel is also only made once, so the amount we get when our adult teeth come in during childhood is how much we have for life. Once we lose it, it’s gone forever and nothing can bring it back.

Are whiter teeth healthier teeth?

Not necessarily. Cosmetically white teeth can be like putting lipstick on a pig. “In fact, having white teeth can give you the false sense of having healthier teeth than you actually have,” says Dr. Michael Apa, DDS. “There could be massive problems brewing underneath the enamel that you can’t see.” White teeth are just as prone to cavities and gum issues as others, especially if you’ve stripped away enamel in the process.

Can you whiten your teeth too much?

Kind of, and it all comes back to the enamel. “When people don’t follow the directions, they can break down their enamel,” says Dr. Mello. “If you break down the enamel, your teeth can not only get sensitive, but also become brittle.” They can also actually look more yellow, since the enamel is the white part of the tooth, the inside is yellower.

If you want to whiten your teeth safely, stick to products prescribed by your dentist or over-the-counter strip products. “It’s a contained dosage,” says Dr. Mello, “so it’s easier to use without harming yourself.” Dr. Mello advises against anything in a liquid and even using too much whitening toothpaste, which is abrasive and can microscopically scratch away tooth enamel.

So is bleaching my teeth bad?

No. “You can bleach your teeth all day long and it’s not going to do anything to your teeth,” says Dr. Apa. “There are only 2 types of bleach that are used in any over-the-counter whitening system: hydrogen peroxide and carbamide peroxide. Both are completely safe to use on your teeth.” Almost anything that claims to whiten your teeth (strips, pens and even toothpaste) will use one of these effective and safe ingredients.

I’ve heard fluoride is bad for you. Is that true?

When it comes to dental health, no. It’s proven to remineralise and strengthen teeth when used topically and, when ingested, helps with bone and tooth health. “Recent research shows it might actually help change the pH in your mouth, so it’s less acidic and therefore bacteria can’t grow,” says Dr. Mello. For tooth decay to occur, three things must be present in your mouth: acid, bacteria and food for the bacteria (like sugar or starch). A lower pH means less acidity for bacteria to thrive in.

The controversy around fluoride, according to Dr. Mello, is not whether it’s good for your teeth, but in the delivery method. “Since the time they started to put fluoride in the water in the 1950’s, it’s always been a controversy,” she says. “It was supposed to dramatically decrease tooth decay. Decay has gone down but it’s very hard to measure the effect it’s had. The correlation is not always there.” It boils down to addressing a three-pronged issue with something that can only address one of those causes.

It is true that too much fluoride can be a problem. “You can get fluorosis on your teeth,” says Dr. Mello. “When there’s too much fluoride, your enamel can get powdery and it chips off. But that can also happen naturally because some water naturally has lots of fluoride in it.”

The bottom line is that the controversy around fluoride is typically centered around putting it in water supplies, not whether it is effective in oral care. In fact, the American Dental Association (ADA) will not endorse a toothpaste that does not have fluoride. While there are “legitimate concerns on both sides” of the water issue, according to Dr. Mello, “there is conflicting evidence.”

Does the type of toothpaste I use really matter?

Yes, and it goes back to fluoride. “If you’re not getting fluoride onto your teeth or into your system, you will get cavities for sure,” says Dr. Apa, which is why any toothpaste should really contain fluoride. Many natural toothpastes do not, so if you want to go natural, make sure you pick a brand that includes it.

“There are specific ingredients that combat certain things,” says Dr. Apa. “For instance, potassium chloride calcifies the sensitive parts of your teeth and decreases the amount of sensitivity you feel.” The best thing to do is ask your dentist what toothpaste they would recommend to you or ask them if there is a specific ingredient you should look for.

Are whitening toothpastes worth it?

It depends on a few things. “Most of them are just abrasive,” says Dr. Mello. “You want to use them very judiciously and not every single day.” The way these toothpastes work is like washing your dishes. Abrasive ingredients scrub away surface stains to theoretically reveal whiter teeth beneath them. This goes back to the enamel issue. If you use them too often or are too harsh in your brushing, you can do more damage than good by removing enamel. Dr. Mello recommends Redmond Earthpaste or at least looking up the abrasiveness of the brand you are using (they are measured on a sliding scale — the lower, the better). When all else fails, “you can also just use baking soda and if you mix it with a little peroxide, it’s even better. The abrasivity of baking soda is surprisingly low,” she says.

Are tongue scrapers actually a thing?

Yes, and a thing you should be using. “You want to make sure you clean your tongue,” says Dr. Mello. “It’s like a shag carpet where all the bacteria grow. A very large percentage of the bacteria in your mouth are on your tongue, not your teeth. They jump off your tongue and go onto your teeth.” Pardon me while I go buy a tongue scraper immediately.

How much does flossing actually matter?

A lot. “It really does make a difference in the health of the tissue,” says Dr. Mello. If you don’t floss regularly (every time you brush your teeth), you could “have a low grade amount of gingivitis (inflammation of the gum tissue) and you’re not aware of it,” she says. “The damage it causes has a cumulative effect and the support for the tooth that keeps it in your mouth gets chipped away.”

Yikes. But how do I know if I’m flossing correctly? “Most people don’t floss correctly,” says Dr. Mello. “They stick it between the teeth and lift up. You’re supposed to hug it on the left and then hug on the right and then lift up.” If that sounds too hard, a water pick may be a good option. “You can use a water pick in lieu of flossing,” she says. “You put the pointy edge of it right under your gum and flush everything out.” She says you can even fill the pick with mouthwash instead of water to really get a deep clean.

When my gums bleed when I floss is that bad?

Yes, but not necessarily that bad. “It’s definitely a sign that you need to go to the dentist and get a professional cleaning,” says Dr. Apa. “It means that you have inflammation in your gums.” Inflamed gums mean that there are infection-fighting cells present in the soft tissue, which over time can cause problems. “Chronic inflammation of your gums can lead to bone loss, which can lead to tooth loss,” he says. “If you floss every day, your gums should not bleed.” It can even start happening if you skip even just a few days. But if it doesn’t go away with regular flossing, you need to see your dentist.

It’s okay to not clean my retainer ever...right?

Absolutely not. “Your mouth is full of bacteria,” says Dr. Apa. “You’re putting bacteria in the little tray, then letting it ferment, and then putting it back in your mouth over and over.” Cleaning it with a retainer cleaner at least once a week is important and Dr. Apa also recommends rinsing it with warm water every time you put it in your mouth.

If I take great care of my teeth, do I still need to go to the dentist?

“That’s like asking, if you jog every day and you eat well, do you still need to go to a physician,” says Dr. Apa. As with with any form of medicine, it’s all about prevention. “Things can spiral out of control pretty quickly in your body,” he says. “If anything happens, you want to catch it early and be able to treat the bigger issue. If you wait too long, you risk making things worse.” That could mean a more painful, time-consuming or expensive treatment to fix what began as a small issue. The average person should see their dentist every six months (more if you are at a high risk of dental diseases, which your dentist could tell you).